A clinical case of choroidal effusion associated with the use of carbonic anhydrase inhibitors

Abstract

Relevance. Choroidal effusion is a complication accompanying both surgical interventions and ophthalmopathies of predominantly inflammatory etiology. The release of proteins from choriocapillaries lumen and decrease of intraocular pressure relative to the pressure in the episcleral veins lead to the chor oid detachment.Purpose. To analyze the causal link between choroidal effusion and topical application of carbonic anhydrase inhibitors using a clinical example.Material and methods. The paper describes a clinical case of the development of unilateral recurrent choroidal effusion 13 years after sinus trabeculectomy associated with the use of carbonic anhydrase inhibitors. The first episode of choroidal effusion was induced by a fixed combination of brinzolamide with timolol, while the use of dorzolamide caused the repeated episode. The clinical picture was accompanied by significant decrease in visual acuity related to acute hypotension and severe folds of the descemet’s membrane. Ultrasonic B-scanning revealed the choroid detachment. The dechallenge of carbonic anhydrase inhibitors, the use of anti-inflammatory and cycloplegic drugs contributed to achieve the choroid adherence.Results. This clinical case clearly demonstrates a causal link between choroidal effusion and topical application of carbonic anhydrase inhibitors. The timely drug therapy made it possible to avoid surgical intervention. Intraocular pressure increased later. Brimonidine was prescribed to reduce it, the intraocular pressure was normalized, and the clinical picture stabilized.Conclusion. Ciliochoroidal effusion may occur in the eyes with primary angle-closure glaucoma even several years after surgical treatment in the setting of the use of this group of hypotensive drugs. It is necessary to take a balanced approach to the use of carbonic anhydrase inhibitors in each particular case, i ncluding in primary angle-closure glaucoma.

Keywords

• choroidal effusion
• glaucoma
• carbonic anhydrase inhibitors
• fixed combinations
• brimonidine
• ophthalmic hypotension